European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders
Abdulbaqi Al-Toma,1 Umberto Volta,2 Renata Auricchio,3,* Gemma Castillejo,4,* David S Sanders,5 Christophe Cellier,6 Chris J Mulder,7 and Knut E A Lundin8,9
United European Gastroenterol J. 2019 Jun; 7(5): 583–613.
Overweight in CD patients is becoming more prevalent with one study showing 40% of patients with CD being overweight at diagnosis and 13% in the obese range
Celiac disease and obesity: need for nutritional follow-up after diagnosis
E Valletta1,3, M Fornaro1,3, M Cipolli2 , S Conte1 , F Bissolo1 and C Danchielli1
European Journal of Clinical NutritionDate: November 1, 2010
Our experience is consistent with the increasing awareness that malnutrition today is quite an unusual presentation in both adults and children with CD. About 80% of children diagnosed in our institution showed a good or fairly good nutritional status and some of them were clearly overweight. Possible explanations of such a finding include early serological diagnosis, interindividual variability in intestinal sensitivity to gluten, prevalent expression of the disease outside the intestine and compensatory absorption in distal small bowel (Arslan et al., 2009).
GFD seems to increase the risk of overweight or obesity, and concerns have been raised about the nutritional imbalance and hypercaloric content of commercial or natural gluten-free food. There is a trend, both in adults and in children, on a GFD to replace gluten-derived carbohydrates with an increased consumption of fats, proteins and hypercaloric beverages and to decrease fiber intake (Mariani et al., 1998; Dickey and Kearney, 2006; Ferrara et al., 2009). Incorrect dietary habits can be induced by unpalatability and expense of commercial gluten-free products or by the availability of commercial gluten-free snacks and biscuits with a high content of lipids.
Adolescents are likely to be at a higher risk of inappropriate and potentially harmful alimentary habits (Mariani et al., 1998). Dietary modifications are more troublesome in countries such as Italy, where people have a high gluten-containing diet (bread, pizza and pasta), but similar dietary imbalances have also been described in Dutch children with CD (Hopman et al., 2006). In conclusion, we would suggest the need for a careful follow-up of nutritional status after the diagnosis of CD, as new morbidities could also emerge in children strictly compliant with GFD. Nutritional advice should be especially directed to those who were already overweight at the presentation of the disease
